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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date issued <br /> ------------- <br /> Applica-l'ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND LOC6TION--- Zt------4,t) ------- <br /> Owner's Name--- <br /> '31�— --------- - ---------------------------------------- -------- Phone <br /> ---------------------------------------------------------- ------------------------------------ <br /> -------- ------- _1V <br /> Address--------- ------4;,�------- -------------------------------------------------------------------------------------------------- <br /> Contractor's Name------ ------------------ PhonW--,e.. <br /> -------------- ----------- ------------------------ <br /> Installation will serve: Residence E] Apartment House E] Commercial ] Trailer Court F] Motel 0 Other E] <br /> Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ------/ ------------------------- <br /> Water Supply; Public system El Community system [I Private [A Depth to Water Table rl_6 ft. <br /> Character of soil to a depth of 3 feet: Sand C& Gravel ❑ Sandy Loam f:j Clay Loam E] Clay [-] Adobe E] Hardpan 0 <br /> Previous Application Made: Yes L] No C& New Construction: Yes 0 No N_ <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank- Pe"t <br /> is a nce from nearest well ,--- --------------Distance from foundation--------------------Material------------------------------ ------------------ <br /> tcompartments--------------------------Size--------------------------------Liquid clepth--------------------------Capacity----------------------- <br /> Disposal Field: Distance from nearest well...----5.:�' Distance from foundation Distance to nearest lot line---- T <br /> Number of lines___________._____j ---- ----------Length of each line------------- -.,_;-.--Width of french------17-1---�L............... <br /> Type of filter material---- '- Depth of filter material___.._P��-------..Total length---------V_,St-----------------­---- <br /> ;7 -_ <br /> Seepage Pit: Distance to nearest well--------------------.-Distance from foundation--------------------Distance to nearest lot line----_----_-_. -.. <br /> ❑ <br /> ine------------ <br /> 11 Number of pits----------------------Lining material-----------------------Size: Diameter---------------__..__.-Deptk-- -------------------•---------- <br /> Cesspool: Distance from nearest well--___________.__Distance from foundation___________________ Lining material__.______._______________________ <br /> �] Size: <br /> aterial------------------------------------- <br /> Size: Diameter------- --------- ------- ---------Depth.------------- -----------------------------------._Liquid Capacity-.------_------------------gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- <br /> ❑ <br /> uilding ----r------------------------------------ <br /> ElDistance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- <br /> I v1 <br /> RemodeWlin ancl/or repairing (describe):------6,Ax!--------- _f5:!rt4-_•_!- '. , <br /> 2-1------------- ------- ---- <br /> ------------------------------------------------------------------------------------------------------------------------------------------ <br /> ------------------------------- --------------------------­­­---------------------.........I—-------•--------------------­_­­------------------------------------------------------------------------------- <br /> I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances. Stafe ws, and rules and regulations of the San Joaquin Local Health District. <br /> (Signed}_.... ------if----------5- -------- --------- ----(Owner and/or Contractor) <br /> ------------------------ ------------- ------------------ <br /> (Plot plan, sliowing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED <br /> BY-V-- ----------------__------------- --------------------------------------------------- DATE_ -- --------------------------------------------------- <br /> REVIEWED BY-------------------------------- ---- --------------------- --------------------------------------------- --------- DATE--" <br /> �;�--------------------------------------------------- <br /> BUILDING PERMIT ISSUED------------------ ---------------------------------------------------------------------------------- DATE--------'`----------------- <br /> Alterations and/or re commendaf ions-_/---- ------------------------------- <br /> ------------—I------------------------------------------------------------------------------- <br /> ----------------------------------------------------- <br /> nA' A 0_4 <br /> ------------------------------------- ---llt!-e ------------- = ------ ' -------- <br /> t---------- <br /> -- ----- ---------- ------ --- <br /> ---------------- <br /> A-F---------- -------- --- ----------- --- ------------------ ---------------------­------­­---------- <br /> - ------- ---------- ---------------------------------------- <br /> ------------- ............ <br /> ----------------------- --------------- -----------i----------------- ------ Date--------------------------------------- ------ --------------------------------------------- --------------- ------ --------------- <br /> ---------4. --- ----- <br /> FINAL INSPECTION BY:-- V/------------- <br /> /-- --- ----------------------------------- <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> ES-9-2M 195446 ATWOOD 12.54 <br />